I needed to get 2 crowns done on my 2 front teeth. My insurance max per year is $1000, so the dentist recommeded that I get those two done separately. They confirmed that it would be billed separately as well, so one will be placed in 2009 and the next one in 2010. Then they recommended that I do a temporary crown on one of the teeth, so that the permanent ones (both placed in 2010) will be done together and will match exactly. And again they reassured me that it would count towards 2009. I made sure that I asked them about 10 times if they are positive my insurance was not going to bill them for 2010 - they said no. Now about 3 months later I am getting a bill from the dentist office that is 90 days overdue. I called them and asked what was going on, and they said that I went over my $1000 limit in 2010. They said that although the two crowns were billed separately, the insurance won't cover a crown till it's seated. As stated before, they were both seated in 2010. I tried arguing that they convinced me to do it that way (I have never had a dental insurance before, so I had no experience). They told me that my insurance company was an exception, most insurance companies would bill those crowns separately. I am covered by Aetna, so it's not that it is a small company that would have excpetional policies, so it is interesting how the dentist office is acting now. I just called Aetna, asking them to show me where it is stated that a crown cannot be billed on the day when a temporary crown is placed (because this is when I was billed and paid my portion!). I looked everywhere on their website prior to calling them. Their rep told me that my employer should have all the detailed information (which they don't - I just asked), or it is my responsibility to find it. I asked her to at least tell me where to look for it - it is their policy, is not it? But she refused to give me this information - probably because she did not know where to look for it either. So, I am just wondering what, if anything, I can do in this situation to minimize the bill that I was told I would never even get! Again, I am very new to this, so I appreciate any advice or input.

Ok, you really did not have it done in 2009, ( right) you and the dentist was going to do insurance fraud and show it being done last year, to get them to pay double the proper yearly amount ?

Is that about the summary of it.

So the insurance company most likely figured this out and denyed the claim.

You can refuse to pay and explain to the judge that you and the dentist were going to defraud the insurance company and it did not work, so now you don't want to pay the dentist.
And silly as it seems, a contract based on a criminal enterprise is not collectible. But you have to admit to a crime to not owe the money.

Personally I would work out a payment plan, you got it done, insurance refused to pay, and you need to pay for it

So I think what you are trying to say is that your DDS prep the one tooth in '09 and the other in '10, then, the DDS placed both the perment crowns in '10. A good DDS and his staff would know that a lot of Ins. Co. like to ask the seat date. And a good DDS and staff should know that the work is not completed until the perm. Crown is placed. Therefore, that is when the DDS office has to come clean and tell the truth. Since they do that, I would not completely say your DDS did anything fraudulent. As far as your bill, I would very kindly and professionally talk to your DDS and make him look you in the eye and ask him how he plans to work this misunderstanding with you. (I would not talk to any of the staff, because they might not have the authority to take money off your account that you owe.) I hope this helps you out. Good Luck!

Your insurance should have had no problem paying for both IF:
1. The teeth were both prepped in 2009. At the prep appointment both teeth would have had temporary crowns made while the case was at the lab.
2. ONE of the crowns was permanently cemented in the year 2009.
3. The SECOND crown was permanently cemented in the year 2010.
As long as your insurance coverage was an ANNUAL coverage and not a FISCAL coverage.

You should ALWAYS have a dentist send in a predetermination before you have any kind of major dental work done. If that had been done, you would have seen how the insurance works because they would send you the reply.

Unfortunately you don't have a leg to stand on unless your dentist gave you an estimate in writing explaining how the insurance claim and payment would work.

Thank you all for your answers, I appreciate it! And yes, it looks like unless I figure something out with the dentist verbally, I will have to cover the bill... I did not have a preestimate or anything like that, I was not even aware of such a thing, so lesson learned! Thanks again!

I have worked in a Dental office for 20+ years. The ADA and local dental society taught Dentists that the initial prep, FINAL IMPRESSION date is when the service is charged. That is when the "treatment" is done and lab billed... this is how it should be. No fraud was committed by this. This is how it should be done. Insurance companies try to make the rules up as they go along. Looks like to me the dental office you go to was just trying to help you get the most out of your dental insurance to begin with.